Chapter 1: What is the main topic discussed in this episode?
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Now, of course, curing cancer is like the holy grail of medical research. It's something we strive for without perhaps the expectation of success within our lifetime. And that's largely because cancer is not just one thing, but a category of many different conditions that all present their own challenges. But that doesn't mean we aren't making progress in a number of fields.
And it happens that some of this progress is happening here in Ireland. Paul Kelly is a medical director of the UPMC Cancer Network. He joins me now. Welcome to the programme, Paul. Thanks very much. Tell me about INSPIRE.
So INSPIRE is a clinical trial that's going to run across the country, both north and south. And this has several novel aspects to it. It's focusing on localised prostate cancer. And this is a radiotherapy clinical trial. And what it's doing is essentially utilising the best that we have in terms of radiation technology and applying that
to localize prostate cancer with a view to particularly focused on reducing treatment-related side effects. So as many of your listeners will know, the prostate is located very close to the bladder and the rectum, the lower end of the bowel. And this poses a problem when it comes to both surgery or radiation in that those areas
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Chapter 2: What is the significance of prostate cancer research in Ireland?
Yes, that's a great question. And really, there are different what are called phases of clinical trials. So Inspire, the trial that we've just opened and is opening around the country, is what's called a phase two trial design. So essentially, there is no comparative group in that trial.
Every patient who decides or puts their trust in us to enter into this trial will receive the experimental treatment. But there are also comparative trials where, as you say, we have a control arm. But often one of the issues with that is that those trials have to be very large to answer questions. And also patients need to be followed in those trials for many, many years.
And they're extremely expensive to run. But, you know, as a technologist yourself, Johnson, AI and modern technology is coming to our aid. And trial design is also something that's going to change rapidly over the next few years to help us answer these questions. And I suppose trials have always been done kind of in academic centres. They've required lots of visits for patients.
And really, you know, a kind of more decentralised oncology trial is going to become easier more involved, that would reduce the burden on patients, really, in terms of their ability to do things remotely, whether that's visits, home blood collections, wearable monitoring, telemedicine follow-up. You know, these things are definitely, you know, going to help.
But in terms of the control arm, there's even the idea, this idea now of an AI-generated, what's called a digital twin. So within a trial before, you know, one person was put into the experimental arm, one person was put into the standard treatment, and they were followed for many, many years to decide ultimately whether there was a difference at the end of the day. But
Yeah, we can now actually even potentially generate an AI digital twin for the person so that we don't potentially have to randomize someone to a control arm. So a bit like everything else in technology, you know, this is really going to advance how we do clinical trials. And there's a very much a trend of incorporating, you know, emerging technology into clinical trials.
So if... I mean, most trials are funded by somebody, right? All trials are funded by somebody. If this is a concentration, are you using a new technologies or a pharmaceutical or a med tech company that is co-funding this? Or is this just a better practice approach?
Well, I'm really glad you brought that up because I suppose most people, when they think of cancer, clinical trials, they may be thinking about drug trials.
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Chapter 3: How does the INSPIRE trial aim to improve prostate cancer treatment?
And often those trials, like you say, are backed or funded or at least part funded by the pharmaceutical industry. But in my own specialty of radiotherapy, There is no pharma company. And actually, it can be quite difficult to attract funding to run clinical trials. And in Ireland, we're lucky that we have a network of clinical trials for oncology called Cancer Trials Ireland, who are helping...
to design and deliver this trial for us. And in this particular trial, there is some philanthropic funding, but also the trial is being backed by one of the gel spacer companies that reduce the rectal side effects.
Okay, so this is an Irish trial.
we um we do the work we realize that actually this guided radiotherapy image guided radiotherapy so we're using imagery all sorts of scans that really guide this to be super precise this uh this radiation beam to reduce side effects it's a massive success right let's say let's just imagine it's really successful and and and the the side effects are much much reduced
We then do what with that information? Does everyone who has prostate cancer after that now get this treatment?
Yeah, so essentially the trials are how we move the dial to the next standard of care. And that is a really important message because without clinical trials, really things, you know, stand still. And it's only by patient's agreeing to go into clinical trials and also, you know, health systems actually running clinical trials that we can answer these questions.
And that's how the whole process moves along and that treatments improve. And actually, this trial is also not unique, but it has patient involvement right from the get go in this study. And patients in Ireland have been involved in helping us design this clinical trial.
And this is really important because I suppose historically, more paternalistically, often doctors were deciding, OK, we'll run this trial because I think this is a good question. But increasingly now, patients are involved in the research and actually helping to design and deliver the clinical trials themselves.
And you can see this trial is all about focus on quality of life, because thankfully, more and more men with localised prostate cancer survive and are cured of their cancer. But they may well be living with the side effect of that treatment.
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